Open City, by Teju Cole

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Julius, a medical student from Nigeria in New York City on a psychiatry fellowship, starts walking around the city in his free time. Sometimes he has a particular destination, but more often he just sets off aimlessly. On his walks he sometimes notices other people or has brief encounters with strangers. Sometimes he visits a former professor, now old and in poor health. Mostly, though, he lets his thoughts wander, ranging over his past and future and that of the city.

There is a long tradition of mostly nonfictional accounts of walking journeys. Here, we are entirely in Julius’s mind and constrained by what he chooses to reveal. Remembered scenes are recounted through his filter. In a novel like this, without other characters—the few who appear more than once are only sketched in—or a traditional narrative with dramatised scenes, what holds a reader’s attention is the quality of those thoughts.

Julius is in his early 30s, so his thoughts have an existential tilt. Within the mosaic of the city’s streets and his life there, both of them shadowed by the events in their pasts, he thinks about death, how he has gotten to this place, and what “this place” is. He questions his choice of profession and even if psychiatry can actually help people.

He appears to be an extreme introvert. At the start of the novel he has more or less broken up with his girlfriend of a few months; they have drifted apart since she moved cross-country. He has one, unnamed friend—referred to only as “my friend”—who moves away by the end of the novel. He enjoys his new activity of occasionally visiting with his former professor, but the professor dies. He encounters a woman from home who remembers him, but he seems not to remember her. Meanwhile, he walks alone.

I was intrigued by the form of this novel and surprised that it held my attention as much as it did. Julius is an unreliable narrator, but we only have his words and perceptions to go on, so that added a level of interest. I was curious to see how Cole would bring structure to the seemingly random string of events. The structure he worked in was subtle but sound.

Also I have long been enthralled with the way the past colors the present, especially in terms of places. I loved W. G. Sebald’s Rings of Saturn and knew that Cole counted Sebald as one of his big influences. However, I would have enjoyed the book more if I lived in New York City. Cole takes it for granted that we know all these places—streets, neighborhoods, buildings—and for the most part doesn’t bother describing them. Since the city is the main character, this lack left a huge emptiness in the center of the book.

The other lack I felt as I finished the book was the sense of an ending. Nothing was resolved; the questions that were raised throughout the book were not answered; Julius seemed to have achieved no insight into his own heart or integration of his divided self.

Cole’s voice, filtered through Julius, stays with me, despite some of the flaws in this novel. I will certainly read more of his work.

What account—fiction or nonfiction—of a walking journey have you read? What did you think of it?

My Beloved World, by Sonia Sotomayor

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These days I’m on the lookout for positive stories. I can only bear an hour or two of news early in the day, leaving me time to bury my dismay and disgust with normal daily activities before darkness comes.

I came to this memoir by the Supreme Court justice—the first Hispanic and only the third woman—with some hesitation. I knew it would be a story of success, but feared it would might be saccharine and superficial.

I needn’t have worried. Sotomayor is an excellent writer. Her prose is clear and flows well, developing scenes and narrative that a reader can easily follow. I think this skill must have been honed in her written arguments, where logic and emotion must both be consistently deployed.

It can be hard to find the right tone in a memoir. You have to describe your successes in a way that doesn’t come across as bragging, not even a “humble brag”. You have to talk about the obstacles in your way without whining or succumbing to a woe-is-me mentality. You have to be open about your failures.

Sotomayor starts by describing a scene soon after her diabetes diagnosis when both of her parents argue about giving her the insulin injection she needs. Burdened by their sadness, seven-year-old Sonia decides to learn to prepare the injection and give it to herself. The scene is a good introduction, not only to the challenges facing her—illness, financial hardship, cultural difference—but also to what she calls “the native optimism and stubborn perseverance I was blessed with.”

I understand. I often say that I am lucky to have been born with the happy gene. I’m less good at perseverance, but Sotomayor shows in situation after situation how extra effort can compensate for other gifts.

What keeps this memoir of her successful rise in the legal world is two-fold. For one thing, there are plenty of stories of failures mixed in with the successes, misery among the happy times. The other is the credit she repeatedly gives to others who have helped her along the way. On the first page of the first chapter, right after her remark about optimism and perseverance, she says:

At the same time, I would never claim to be self-made—quite the contrary: at every stage of my life, I have always felt that the support I’ve drawn from those closest to me has made the decisive difference between success and failure.

It is this generous spirit, shown also towards her parents where her love for them shines through even when she describes their failures, that makes me want to cheer her on and give her more credit than she gives herself.

Another challenge of writing a memoir is deciding what time frame to choose. I think she made a wise choice to start with her independent approach to her diabetes and end with her first becoming a judge. Since becoming a judge was her dream from the beginning, it ties up the story neatly.

If you’re feeling low, I recommend this book. As she says in the preface, “People who live in difficult circumstances need to know that happy endings are possible.” Although our circumstances are dissimilar and our ideas of what makes an ending happy differ, her story lifted my own spirits.

What book have you read that brightened your day?

Playlist 2017

Songs are stories too. And sometimes poetry. In this year of much darkness and much light, I turned to true stories, songs that gave me courage, and old favorites. Many thanks to my friends for their music.

Blues Run the Game, Jackson C. Frank
Mill Towns, David Francey
Far End of Summer, David Francey
Get Behind the Mule, Tom Waits
Hold On, Tom Waits
House Where Nobody Lives, Tom Waits
Sometimes I Feel Like a Motherless Child, Jacqueline Schwab
Lately, Aengus Finnan
Lass Among the Heather, Keith Murphy
C’est Aujoud’hui Grande Fete, Keith Murphy
Waves, Margie Adam
Lighthouse, Cris Williamson
Morning Glory, Terry Garthwaite
Doc Con Xa, Pham Van Ty
Le Morvandiaux Cesar’s The Sound of Sleet, Jeremiah McLane & Timothy Cummings
Bourees 3 Temps, Jeremiah McLane & Timothy Cummings
Keys Meadowhawk Mstr V2, Jeremiah McLane & Timothy Cummings
Let Me Fish Off Cape St. Mary’s, Keith Murphy
A Psalm of Life, Jacqueline Schwab
Loftiδ verδ ur skyndilega kalt, Ólafur Arnalds
ρu Ert Sólin, Ólafur Arnalds
ρu Ert Jöδin, Ólafur Arnalds

Collected Poems, by James Wright

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If memory serves, before now I had only read one poem by James Wright, his most famous one: “The Blessing”. I was drawn in and held by the gentle images, too specific to be sentimental, until the final image hit me like a fierce wind, lifting me out of this life.

The poem is a perfect example of Robert Bly’s concept of “leaping poetry” which I discussed a few weeks ago. That is no accident. I’ve come to find out that Bly was not only a friend to Wright but also a mentor.

If I liked the poem so much, why didn’t I read more of his work? All I can say is that I meant to. This 1971 collection of his poems, which won the Pulitzer Prize, is a good way to do that. It contains a good selection from his earlier books along with a section of new poems and one of translations from writers such as Neruda, Vallejo and Trakl.

As I read the selections from his first book, The Green Wall, I wondered if this could be the same poet. They seemed complex and overly elaborate, like something from an earlier age. However, I did appreciate his themes of estrangement from nature (symbolised in the green wall), the horrors of the modern world, and mourning.

The poems from his next book, St. Judas, went further into the hearts and minds of the poor, the criminal, the disenfranchised. Growing up in Martins Ferry, Ohio, during the Depression, he witnessed poverty and suffering first-hand; the only thing worse than a soulless factory job was having no job at all.

A bad review from the poet James Dickey led to an angry exchange of letters. However, upon reflection, Wright allowed that Dickey’s criticisms had merit. He let go of 19th century poetic traditions and, working with Bly and others, found a new, more direct style. By concentrating on images instead of stylised meter and rhyme, by using plainer language instead of rhetorical flourishes, he began writing the kind of amazing and transcendent poems that I originally fell in love with.

Wright’s next collection, The Branch Shall Not Break, was widely praised and influenced poets such as W. S. Merwin, Sylvia Plath and Galway Kinnell. I loved the poems here and in the remainder of the book. Of course, some are more successful than others and perhaps he overuses the technique of the leaping last line, but there are real gems here.

Wright dedicated one of the poems in Branch to Dickey, who became such a fan that he wrote a glowing blurb for the Collected Poems, saying:

James Wright is one of the few authentic visionary poets writing today. Unlike many others, James Wright’s visions are authentic, profound, and beautiful . . . He is a seer with astonishing compassion for human beings.

I think this episode with Dickey is a good lesson for any writer. It’s normal to feel defensive when your work is criticised. However, if Wright had continued to hold out against Dickey’s comments, he never would have experimented with changing his style. He would never have become the beloved and influential poet we know today. He never would have written the poem that lifted me out of myself and made me seek out this book.

Have you ever received a criticism that you initially thought was unfair but later recognised had merit?

Oracle Bones, by Peter Hessler

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Although several years old now, Hessler’s book offers a good introduction to a country that is rapidly changing. Presented chronologically, the stories of people and places and artifacts span the years from 1999 to 2002, when Hessler worked in China as a teacher and journalist from. As in the best of today’s narrative nonfiction, these stories are vivid vignettes that immerse the reader in the experience.

We meet an 82-year-old, tennis-playing man who “carries himself like a soldier” and stubbornly refuses to leave his family home when the developers demand it. We camp in a tower on the Great Wall during a sandstorm, hang out in cafes at night with Uighur traders, and cruise along the banks of North Korea. We talk with peasants and movie stars, archeologists and black marketeers. We learn what a ghost chariot is.

The book’s subtitle, A Journey Between China’s Past and Present, points to the aspect of the book that—next to the stories—most appealed to me. Hessler gives the reader historical context for everything, but so subtly that we can absorb the information almost without noticing it. The trick is that he gives us a snippet of history at the moment we need it and immediately returns to the story.

Also, every two or three chapters we get a section that zooms in on a particular artifact, such as the Flying Horse, discovered in 1969 in the village of Wuwei. Since archeologists were not available in the middle of the Cultural Revolution, the peasants who blundered onto the third century tomb while digging under a temple did the excavation and kept the many bronzes in their own homes until they were finally collected. The background and symbolism of the horse are teased out in a series of interviews that keep the reader’s attention engaged.

Our attention is held, too, by certain people and stories that are carried through the book, such as former students with whom Hessler stays in touch and the mystery surrounding a suicide. Also, descriptions of places come alive with a handful of details, such as this one of the Ju’er neighborhood of Beijing:

Some residents kept makeshift pigeon coops on their roofs, and they tied whistles to the birds, so that the flock sounded when it passed overhead. In the old parts of Beijing, that low-pitched hum, rising and falling as the birds soared across the sky, was the mark of a beautiful clear day. In late afternoons, the trash man pushed his cart through the hutong, blowing a whistle. The sound faded as he made his way out of the neighborhood; usually he was gone just before sunset. Nights were silent.

What sent me to this book were the lovely quotations credited to it in Hélène, by Deborah Poe, such as the epigraph from Chuang-Tzu about the use and limitation of words. My favorite is this from Chen Mengjia, a poet and scholar: “I crushed my chest and pulled out a string of songs.”

I particularly liked Hessler’s evaluation near the end of the commonalities and differences between China and the U.S. We have more in common than you might think.

Change has only accelerated for China since 2002, but this book is a good place to start if you want to understand modern China amid the fragments of its long past.

What book have you read about modern China?

The Dogs of Riga, by Henning Mankell

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I came to the corporate world from teaching where even the most cynical and disillusioned co-worker started from a place of caring about the children. When I started working in the corporate world, however, I quickly realised that there were two sorts of people there: those who cared only about getting ahead and those who cared about the work itself. Inspector Kurt Wallander is one of the latter.

Here, Wallander investigates the case of two dead men washed ashore in a life raft. Apparently in their mid-30s, dressed in expensive clothes with their arms wrapped around each other, both men have been shot through the heart. The previous day, one of Wallander’s younger colleagues had taken an anonymous call that a raft with two dead bodies would be washing ashore. At the time, Wallander decided to alert the coast guards and then wait and see what happened.

Wallander is not averse to waiting. He can act and does, but he takes a measured and intelligent approach to his job. Unfortunately for him, the ramifications of the case take him out of his comfort zone, out of his city and even out of his country. He must take action in an atmosphere of uncertainty, guesswork, and peril for both himself and others.

Once it is determined that the two men probably came from Latvia, Wallander is relieved to turn over the investigation to his Latvian counterpart, Major Liepa, whom he recognises as a policeman after his own heart. When the two talk late into the night over a bottle of whiskey, Liepa explains that he is a man of faith, though he does not belong to a religion. He cares about “the fight for survival”, which to him includes “the fight for freedom and independence.”

Another murder drags Wallander back into the case and sends him to Latvia, where he has to negotiate places, people and power structures that are foreign to him.

This is the third book in the Wallander series, first published in Sweden in 1992. The date is significant because, as Mankell describes in his Afterword, “Just a few months after this book was finished, in the spring of 1991, the coup took place in the Soviet Union—the key incident that accelerated declarations of independence in the Baltic countries.”

While the story is intricately plotted, with many unexpected twists and turns, the real joy of the book for me is Wallander as a character. We see much of his life outside of work: oppressed by the intense cold, navigating a difficult relationship with his elderly father, thinking of his daughter Linda who is away at college, and often missing his friend and mentor Rydberg who has died of cancer only a month previously.

Such scenes, which seem irrelevant to the puzzle of the two men in the life raft, help us with the puzzle that is Wallander himself. And each scene echoes through the story, adding context and color to Wallander’s thoughts and choices and actions.

I love the realism of this portrayal. Wallander gets discouraged; he needs to stop and rest sometimes or eat or use the washroom. He questions himself, at one point describing himself as “a Swedish police officer in early middle age, one who has completely lost his sense of judgment and gone out of his mind.”

But he goes on. Offered opportunities to leave and return to his safe desk in Ystad, Wallander is tempted but plows ahead, driven by the core of integrity that I most appreciate in those around me and in the protagonists with whom I choose to spend my time. These are my heroes, whether sitting at a desk near me or in the pages of a book: however flawed, they labor for something larger than themselves.

Who are some memorable characters from novels you’ve read?

Daniel Deronda, by George Eliot

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George Eliot’s last novel is an ambitious undertaking. We follow two people starting with the moment they first saw each other, in 1865 at a resort in Leubronn, a fictional town in Germany. As young Gwendolyn Harleth plays roulette, she is observed by Daniel Deronda. She perceives that while he is taken by her great beauty, he seems to be critical of her behavior. Spoiled and stubborn, she refuses to stop until she has gambled away the last bit of her winnings, trying to appear uncaring. The next day she is called home by a letter from her mother that they have lost all their money, but not before the necklace she has pawned after her losses is mysteriously returned to her.

From there we go back to learn how the self-centered Gwendolyn and the quiet Deronda reached this moment. Gwendolyn has had everything her own way up to this point, ruling over her social circle despite her lack of wealth, uncaring about others, and demanding to be entertained constantly. Just before her trip to Leubronn with family friends, she has refused an offer from Henleigh Grandcourt, a man whose wealth and position would seem to promise all her dreams would come true. However, she has learned that he has a family already, with his longtime mistress.

Deronda is the ward of Sir Humphrey Mallinger, Grandcourt’s uncle. Like most people, he believes he must be Sir Humphrey’s illegitimate son. A most generous and compassionate man, he misses a scholarship to Cambridge through helping his friend Hans Meyrick to win one. He also rescues Mirah, a young Jewish girl who was about to drown herself, and takes her to the Meyrick family for safekeeping. Through her he meets a mysterious Jewish visionary named Mordecai and becomes interested in learning more about the Jewish faith. This novel is the first to treats Jews sympathetically.

From there the two stories continue in tandem, only occasionally intersecting. While there is a great deal of narrative, common in novels of the period, the tale is enlivened by Eliot’s light touch with dialogue and by her penetrating, and sometimes satiric, insight. For instance, she says “it was evident that Gwendolyn was not a general favourite with her own sex; there were not beginnings of intimacy between her and other girls, and in conversation they rather noticed what she said than spoke to her in free exchange.”

I love what Mrs. Meyrick says of her son: “‘If I were to live till my Hans got old, I should still see the boy in him. A mother’s love, I often say, is like a tree that has got all the wood in it, from the very first it made.’”

Deronda’s story of growing interest in Judaism and what we would now call Zionism is less interesting. In his introduction to my copy, F.R. Leavis disagrees with Henry James that Eliot’s intellectual ability is the cause; Leavis admires her intelligence and intellectual powers. Rather, he blames the failure of this part of the book on Eliot’s persistence in endowing her protagonists with idealism. He calls this “immaturity” on Eliot’s part, and even describes Deronda as being a woman in his desire to make the world a better place.

I disagree. As Donald Maass points out, “Generally speaking, we choose company that is pleasant.” He goes on to ask writers “What kind of person are you asking your readers to spend four-hundred or so pages with?” In another post he suggests that “Positive emotions are harder to access and more difficult to use. Perhaps that’s because they relieve conflict rather than feeding it.” Yet we as readers treasure our encounters with these emotions. “‘Higher emotions’ are called that for a reason. They elevate and inspire us. Even just reading about them changes us, as Thomas Jefferson once wrote and which more recently has been scientifically demonstrated in studies of ‘moral elevation’ by Dr. Jonathan Haidt and others.”

The trick is to make the character interesting by adding internal conflicts and shadings. He or she cannot be all positive. Plus the character has to change. While Deronda has some internal conflicts over who his parents are and whether the woman he loves will also love him, these do not fundamentally change him and he never does or is tempted to do anything wrong. The only way he changes in the book is through his decision to immerse himself in Judaism. He is still his perfect self at the end. Mordecai too is entirely perfect and does not change.

The other reason why the Jewish part of the story drags is that so much of it is presented in long intellectual monologues by Mordecai, unbroken by action or emotion. Today we call this “info-dumping” and try to avoid it.

I don’t think the problem here is idealism, so much as it is the lack of shading in our idealistic characters and the misuse of dialogue to convey chunks of information. Still, there is much to admire in this book. I found myself, despite having read it before, hurrying to get to the end to find out what would happen to these two characters.

Have you read any of George Eliot’s novels? What did you think of them?

Open: An Autobiography, by Andre Agassi

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I always start my memoir classes by discussing what a memoir is. It covers a discreet portion of the author’s life, usually with a limited time frame, and is the author’s perception of the incidents described. Autobiography, on the other hand, is expected to be more objective and to cover the author’s entire life. Therefore, we might question this “autobiography” of someone who is only 39 the year it is published.

Yet Agassi is justified in calling this an autobiography. The frame of the book is his last match as a professional tennis player, at the U.S. Open. From there we go back to his childhood and follow him up to that moment in 2006, that last match. Since almost every moment of his life has been devoted to professional tennis, I think it’s fair to say that one life ended that day and another began. Also, the reworking of Agassi’s original material by another writer, the extensive fact-checking and multiple editorial rewrites provide some objectivity to what is a very personal account.

I love watching tennis, the intense one-on-one battles where the advantage shifts back and forth. The psychological battle interests me almost more than the physical one. A person has to stand out there alone under the unrelenting eyes of cameras and spectators, without teammates or coaches or even privacy to collect themselves. They have to summon the courage to keep playing when they are losing horribly, embarrassingly, and the composure to stay calm in the run-up to an unexpected win.

Reading this book just after Wimbledon gave me added insight into what is happening on the tennis court. Agassi speaks of the “magnetic force” that comes near the end of a match that can pull you over “the finish line” into the win and the equal force pushing you away.

More than that, he gives a close description of the shaping of a professional tennis player, something that starts in early childhood. Agassi’s father gave him a racket when he was three but even before that, according to his mother, “when I was still in the crib, my father hung a mobile of tennis balls above my head and encouraged me to slap at them with a ping-pong paddle he’d taped to my hand.” No wonder he grows up hating tennis and rebelling whenever he gets a chance. Given his seemingly adult-style career, I had to keep reminding myself as he described some of his shenanigans of how young he was.

In some ways, it’s an all-too-familiar story of a childhood stunted and deformed by a stage- or sport-parent who demands that the child’s every moment be devoted to practice. Yet Agassi’s unusual openness about his experiences, his emotions, his misjudgments and mistakes lift this book above the ordinary. The tone is well-calculated to avoid self-pity and show respect and even love for those who might be said to have harmed him.

It’s a compelling read. I was surprised by how well-written it is until I got to the acknowledgments at the end. Agassi credits J.R. Moehringer with transforming their taped interviews into this book, along with input from editors and first readers. He explains that though Moehringer refused to have his own name printed on the cover, Agassi wanted to ensure he got credit for his work. With that, I was no longer surprised. Moehringer is an amazing writer. I’ve written about his extraordinary memoir The Tender Bar.

I treasure the brief outline of Agassi’s second life at the end of the book, a life born of his desire to help disadvantaged children. If we are lucky, we find work that gives our lives meaning.

What sports biographies or autobiographies have you found illuminating?

The Girl on the Train, by Paula Hawkins

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I didn’t want to read this 2012 runaway bestseller simply because of the title. I have had it with grown women being referred to as girls. No one would refer to a 32-year-old man as a boy. The misogyny makes me want to spit.

However, a book discussion group I’m in selected it, so I gave in. In short, it was a fast read about a bunch of extremely unpleasant people. The voice of the initial first-person narrator, Rachel, felt genuine and well-written. The voices of the other two women narrating the story equally well-written, aside from not seeming different from Rachel’s. There was plenty of suspense from one page to the next, though the solution seemed clear early on, but little else to recommend it. However, as writers, we can always learn something from a book.

Rachel rides the commuter train back and forth to a job she pretends she hasn’t been fired from. Morning and evening, she gazes at her former home where Tom now lives with Anna, the woman he left Rachel for, and their baby. She also speculates about the loving couple a few doors down, making up names and stories for them. She also drinks. A lot.

Her excessive drinking has cost her not only her job and marriage, but made her fat and ugly, at least according to her account of what people say to her. More misogyny, anyone?

From the train, she witnesses a disturbing incident at the neighboring couple’s home, and soon after learns that the woman, whose real name is Megan, has disappeared. In between binges, blackouts and drunken, begging calls to Tom, Rachel decides to help with the investigation. In different chapters and a separate timeline, Megan tells us about events prior to her disappearance, lounging at home months after her gallery closed, feeling sorry for herself. Our third narrator is Anna, smug and arrogant in her marriage, while complaining about Rachel constantly barging in and the incessant trains passing behind the house. She misses the excitement of being a mistress rather than a wife; she misses clubbing and nights out.

What these three thoroughly unpleasant women have in common is that they are bored women living privileged lives yet finding endless complaints to fuel their self-pity. Rachel could set aside her multiple gin and tonics or bottles of wine and get another job. A job would be even easier for Megan; all she has to do is get out of the chair. Anna could find social groups and volunteer activities like other stay-at-home moms. Instead they just whine. The men aren’t much better. They all behave badly, and stereotypically so: abusing the women in different ways.

So what makes this novel so popular? I am somewhat mystified. The theme of work versus marriage and children, which could make it resonate for young women, seems falsely set up to me. Everyone behaves badly at home. We only see Rachel at work, and then only an embarrassing memory. One person in my group suggested that Rachel displayed elements of Bridget Jones and so attracted that audience.

I kept feeling that I was immersed in the 1950s—women stuck at home with or wanting babies while under their husband’s thumb—yet I understand that I’m old enough to have been through several increasingly complex waves of dealing with these issues and that each young generation of women has to address them all over again. I also understand that feminism in the UK is on a different timeline from the US. Still, I didn’t think the story treated these issues with subtlety or awareness of all the social history packed into them.

One reason for its popularity could be that it combines genres. It’s been called a literary thriller, a literary mystery, and a psychological thriller. Also, for those looking for a classic hook, it’s a Hitchcock mashup, combining elements of Rear Window, Stranger on a Train, and a third I won’t mention so as not to spoil the story for anyone who hasn’t read it.

Yet, mystery fans will find it very thin, with the red herrings barely mentioned before being casually ruled out and the ending well-telegraphed. The two detectives are barely mentioned and have almost no role in the book. Fans of literary fiction will also find it thin. Rachel is the only one whose inner life is developed, though her character is given plenty of layers and her inner monologue very well-written. More development of the other characters, better tying up of loose ends, and a few subplots would have made for a richer story.

I think it is too shallow to qualify as literary fiction. Outside of the three women the characters are not developed and, while there are plenty of layers to Rachel’s story that are reflected in Anna and Megan’s, there are no subplots involving the other characters.

I guess it’s the thriller aspect. Hawkins does a good job of adding microtension to each page. This keeps the reader engaged and the suspense ramped up, even when you know what’s going to happen. I liked the cover, too. With a blurred background fronted by large juddering text, it grabs your attention and conveys the essense of the story.

Is there a wildly popular bestseller that either thrilled or disappointed you? Why?

Being Mortal: Medicine and What Matters in the End, by Atul Gawande

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When my father was taken ill that last time, he did everything he could to keep from going to the hospital. He tried to hide what was happening, even though as a doctor he knew exactly what it was and what it meant. When discovered, he argued with my mother, trying to keep her from calling for an ambulance, and he fought the EMTs when they arrived. He yelled as he was being carried into the ER of the hospital where he had been chief of staff that he wanted to be left alone to die.

He knew what was going to happen. He was kept alive for three agonising months, undergoing one treatment program after another over his continued protests. His advance medical directive was no protection as his doctors persuaded my mother to override it.

So I thought I knew what I would encounter in this book by Gawande, a surgeon at Brigham and Women’s Hospital. I knew that a huge percentage of medical costs come in the last few months of a person’s life, the problem being that we aren’t always sure that it actually is the end and not just another stage where recovery may be possible. I had also seen a friend’s family want to deny her treatment because they were concerned about the cost of assisted living and later a nursing home.

And, indeed, Gawande speaks directly to the issues around my father’s last illness.

. . . in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.

The book is a surprise, though. Gawande examines these issues through stories of his patients and his own family, encouraging us to look at that phase of life that we mostly try to pretend will never happen, that inevitable decline into death. Most interesting to me, he takes us through the history of solutions for how to make the end of life meaningful, comfortable and affordable, from the first retirement communities to exciting new ideas.

New to me was the story of Keren Brown Wilson, one of the originators of the idea of assisted living.

Wilson believed she could create a place where people like Lou Sanders could live with freedom and autonomy no matter how physically limited they became.

The key word in her mind was home. Home is the one place where your own priorities hold sway. At home, you decide how you spend your time, how you share your space, and how you manage your possessions. Away from home, you don’t. This loss of freedom was what people like Lou Sanders and Wilson’s mother, Jessie, dreaded.

Some later adopters of her concepts have not stayed true to her vision, instead returning to the idea that safety is the only thing that matters. Gawande astutely points out that it is usually the children of the elderly making decisions about care, and they are more concerned with the safety of their loved ones than with their possibly risky independence.

I was overjoyed to learn about Bill Thomas’s work as medical director at a nursing home in upstate New York. Throwing out the safe option of keeping the elderly drugged and confined to wheelchairs, he filled their room with parakeets and plants. He added a day care center, so the residents could interact with children, to their mutual benefit. To the surprise of everyone but Thomas, these changes brought immediate improvements in patient outcomes.

The stories of patients and providers, along with Gawande’s stories of his own family’s confrontations with these issues makes this an enormously readable book. The stories bring the science to life.

All we ask is to be allowed to remain the writers of our own story. That story is ever changing. Over the course of our lives, we may encounter unimaginable difficulties. Our concerns and desires may shift. But whatever happens, we want to retain the freedom to shape our lives in ways consistent with our character and loyalties.

I would have liked to see Gawande address the issues related to the people working in these institutions. Yes, the structure of the institution and the principles behind that structure are the first step, but you must have people on the ground to carry them through on a day-to-day basis. As our population ages, care homes of every type will have an even harder time than they do now finding and adequately paying workers. We need to be thinking of how to expand our workforce of compassionate and well-educated people willing to take on an often unpleasant job.

Still, I am thrilled with this book. I hope it opens a much-needed conversation. My father would have loved this book and talked about it with everyone he met.